TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hi.

CLIENT: You know when you get really stuffed up and your ears start to not work properly? As it happens they’re opening and closing right now, all the way down here [inaudible at 00:00:20]. I really [inaudible at 00:00:24] almost any of this I must look a little funny. Whatever. I don’t have many people around right now.

I’m pretty far in it a lot. There’s been moments and times when I can kind of pull back and say this too shall pass and things are going to get better probably. But I don’t, it’s hard for me to sort of have perspective most of the time. [00:01:34]

[Pause]

I told James that things were sort of getting pretty bad. I said I don’t know how bad it is. He said that looked good.

THERAPIST: Sorry.

CLIENT: That’s okay.

THERAPIST: Yes, you told him that you don’t know how bad it is?

CLIENT: Yes. He kissed me and I started crying uncontrollably so that, I felt some explanation was called for. We will see. [00:02:42]

[Pause] I really don’t want to go to work but it’s probably good for me, a good distraction for me.

THERAPIST: I guess it seems to me that you’re both feeling pretty hopeless and uncertain and finding me as well to be pretty helpless and uncertain about as far as being able to do anything about how you feel. [00:03:55]

CLIENT: Yes, I guess that’s right. I just really don’t want this to be happening. I really don’t want to be here again. I don’t want to be feeling this way and I don’t want to have to deal with any of the fallout. I sort of think about the ways in which we’ve handled it in the past and I don’t want to do any of those either. So, yes, I do feel sort of helpless. [00:04:34]

And I can, like I said sometimes I can sort of step back and say well I’m not in the same place that I was a year ago. This isn’t the same and it’s not the cycle that never gets better. And I have all of these factors in my life that’s sort of helped me stay stable and I’m better at pulling out of it, like I’m better at sort of regulating myself. But this doesn’t bear a lot of weight. [Laughing] Yes, I guess, I don’t know, it sort of feels like none of my choices are good right now. [00:05:43]

THERAPIST: I guess the other sense I get or that you say is that you’re very frightened.

CLIENT: Yes.

THERAPIST: I imagine either that you will be dead or that you’ll go to the hospital and once there, whatever will happen in the [inaudible at 00:06:19].

CLIENT: I’m just frightened that, I’m frightened that this will just keep going, you know? And I’ll go to the hospital and have to deal with that but then also have to deal with sort of the aftermath of that, or that I won’t go to the hospital and I’ll just keep feeling shitty for weeks and months. I think about committing suicide and I don’t see any way for that not to be really, really terrible for everybody around me. And so then I think well, I guess I’ll just have to feel the same way, really, really terrible for me for a while. And I don’t like those choices. [00:07:37]

THERAPIST: Yes. Eventually [inaudible at 00:07:56] are both really horrible.

CLIENT: Yes. And maybe I’ll just turn around this week and that would be great. Except that then there’s also, I’d still just feel pretty helpless. I don’t know. [00:08:25]

THERAPIST: As though this is kind of just being done to you in a way you have, you or anybody else has regular control over?

CLIENT: Yes. That’s what it feels like. And [00:08:56]

THERAPIST: And it can kind of come and go at any time, more or less?

CLIENT: Yes, yes. Yes. I guess I part of me really wants to say that that’s not actually how it is and I do have control over it and blah, blah, blah. But I don’t know about that. Part of it also is James is very uncomfortable with the fact that I feel so helpless, in fact I feel like it’s just something that happens to me or that’s done to me. And I see his point, he likes people to have agency. [00:10:15]

[Pause]

But I can still get up and go to work and do laundry and do the things that I need to do to sort of stay in the world. So, get to work. [Pause] I don’t know. It sort of feels like the things that keep me stable right now or that are good in my life are contingent on my continuing to be okay. [00:11:59]

THERAPIST: You mean like work where it helps but you sort of be in good enough shape to get there kind of?

CLIENT: Yes, certainly. I sort of feel that way about church stuff, not to the same extent or the same kind but I don’t I feel like my role in that community is one of somebody who does stuff and is helpful and I feel like it’s not easy for me to tell people there that I’m really not doing well. Part of that is honestly the priests there don’t really follow up with me when I’m not doing well and that’s always sort of hurtful and disappointing. And so I don’t want to put myself in a position to be hurt and disappointed. Which I guess the way to fix that is just to tell them and make it clear what I need. I’m not sure that I’d actually do it but that’s probably feedback they should hear. [Laughing] Sorry, sort of I’m thinking. [00:13:48]

THERAPIST: Well I think you’re also in a way expressing some frustration in clearly I think in a very subjective way that I think is appropriate about other people’s limitations, being able to be there for you or help you. I mean I think it’s easier with the priests in a way because they’re kind of bucking up. But I think, like with work and I imagine it’s complicated with James or that he was sort of the third instance I’m thinking of that you kind of had him to be. [00:14:40]

And with me as well, I think there’s a level in which it feels like none of us can really help in certain ways that would really matter. And I think there are moments that are frustrating and other ones that are scary. Or with work I guess as an example but you’re going yes it does help in you’re in good enough shape to get there. And I know you know in a way that if you’re not, it’s not their fault. [00:15:42]

But in another way I imagine it’s either sad or frustrating or something that passed a certain point you’re kind of on your own. There’s a degree in which they can’t come to you. [00:16:03]

CLIENT: Yes. And you know it’s not really, it’s not ultimately useful to talk about the sort of specific ways in which they can’t come to me because when people, when people really try to come to me and be there for me there’s only so much that does. There’s still that point in pass (ph), which is look, I just have to do this.

THERAPIST: I wonder if you’re saying that to anyone in particular. I mean I mean me.

CLIENT: No, I don’t I was thinking about people like [Jason and] (ph) Candace that seen me last year and I said that was both nice and made me feel really loved. And also on some level it didn’t really matter. I don’t know who I am. [00:17:37]

THERAPIST: [Pause] I kind of think that goes to I’m trying hard to help and to be there and so it would be hard to tell me about the limitations and what it could actually do and the sort of points after which I kind of can help. [00:18:23]

CLIENT: I don’t know. I mean maybe I’m feeling that way but you see that in my first reaction is [inaudible at 00:18:30]. You probably know pretty well the limits of what you can do [laughs].

THERAPIST: Fair enough.

CLIENT: I feel like that would be pretty inescapable.

THERAPIST: I see. I see and I guess the idea is, yes, I can see how it got to be reasonably one where I can live with that.

CLIENT: Yes. That’s one of the things I really trust about you. You don’t seem to take it personally. [00:19:12]

THERAPIST: I see.

CLIENT: So then [inaudible at 00:19:23] take care of you.

THERAPIST: I see, yes. That’s good.

[Pause]

CLIENT: Yes, it’s sort of like I see what you’re getting at. I’m just not really sure where I fit into it, how well it fits. So one of the things that I was thinking about and sort of imagining is well if I do end up having to be hospitalized again what the hell do we do? I do not I can very easy envision a scenario in which my treaters at the hospital got very frustrated at me because I don’t seem very fond of medication and I’m not particularly interested in retrying any of it if it didn’t work the last time. I am not interested in doing ECT again. I’m not so that sort of leaves short term, sort of two-week programs and you and I don’t [00:21:39]

So it’s well basically just keep doing what we’re doing is the plan and I don’t know. And I don’t know whether that’s something that I find sort of reassuring or scary or both.

THERAPIST: My money’s on both.

CLIENT: It seems like I think that. [00:22:16]

THERAPIST: Yes.

CLIENT: But I mean one of the things that sort of frightens me about the idea of needing to be hospitalized is that I tend to get a lot of pushback about doing analysis like this. And I don’t want to have to deal with that. I feel like I sort of get put in the position of having to sort of strongly defend my treatment choices and I don’t and maybe I’m just sort of in the position of having to strongly defend my treatment choices to myself right now and that’s why I’m thinking about it. But I don’t know. [00:23:49]

[Pause]

THERAPIST: Okay, well it does seem like you’re saying I think there’s something going on which is this. So my first thought is you’re talking about how others sort of play the [inaudible at 00:24:56] up on the way through. My first thought was yes, I guess Tanya’s right. At the end of the day there’s sort of relatively brief hospital stays and then you take your medication, you’ve done a bunch of groups and I get that’s right. [00:25:13]

And then I thought, well yes, that’s true those are the options but actually there are a whole, there’s a collection of [inaudible at 00:25:25] that go on around your being in the hospital and things actually do change. You tend to you get, at least so far, you’ve gotten to a point where things get bad to a certain degree and you say okay I’m cooked; take care of me. And you go to the hospital and it’s actually kind of a relief because the burden isn’t as much on you to keep from killing yourself I think. You know they [00:26:06]

CLIENT: Yes, that’s a nice feeling. [Laughs]

THERAPIST: Yes, they carry that for a while and I guess they’re really in a way the only ones who can. I mean you know you can call me and I’ll sort of kind of take over, but it does require stepping up in some ways on your part, where the hospital I think really does it. Once you’re there my sense is it feels like they’re carrying a lot of that burden. And that is a relief for a while and then you really want to get out of there. And I think then there’s kind of re-entry and worry that usually that does provide, has provided some respite for you for a little while including after you’ve left. [00:27:07]

And then you mentioned about their kind of not being happy with you for not wanting to help and also their giving you a hard time about analysis. And I guess I have two thoughts. I only remember one time that really happened but maybe it happened more than I really knew about.

CLIENT: I remember at least a couple of times. But both times with people who were sort of primary people in charge of my care so if they don’t like it the crap sort of trickles down. And I’m probably exaggerating it but it sort of looms large for me.

THERAPIST: Right, yes, and I think that’s the piece that I was marshaled (ph) into. And I think a big reason it looms large for you is because with this as well I think you in some ways and maybe oftentimes feel taken care of. And I think you’re kind of very sort of sensitive to or vulnerable around people saying things that made you feel like well you’re being taken care of too much. Do you know what I mean? [00:28:42]

CLIENT: Yes. [Laughing]

THERAPIST: And so I think that’s actually a similar thing with a hospital too. I think your thoughts, to me it seems like you were kind of unconsciously a little dismissive of how the hospital can actually help, can in another way make you feel a bit taken care of. So it seems to me in both instances that what you seem to be kind of, I don’t know, sensitive around in a way and sort of warding off a bit is, I guess, there’s really a conflict around really wanting to take care of and really feeling like you need it and feeling like you’re going to get in big trouble for it. So that either it doesn’t exist, the hospital’s just the same as any other place, or they’re going to give you shit about analysis and then you’re going to have to give that up is it. [00:29:54]

CLIENT: Yes, that makes really good sense. I feel like I told James that things are pretty bad and he said you know you can ask for help and it’s sort of awkward to help you with the things that you’re doing [inaudible] and he said I want to let you ask for help and not sort of steamroll you. You can ask. And it’s sort of like okay you have no idea what a barrel of worms that is. I said okay. [00:30:39]

THERAPIST: It’s funny, it may be a different expression. I know the expression I’ve heard is a can of worms. But you upgraded to a barrel. [Laughing]

CLIENT: I think I was thinking also of a barrel of monkeys or something. Yes. [Laughing]

THERAPIST: There’s probably a bag [inaudible at 00:31:07].

CLIENT: Yes. I think that makes me uncomfortable when you sort of suggest ways in which I might be sort of feeling hopeless or feeling frustrated about with you and kind of like this because I do feel like I really get taken care of here. I don’t know how to and so then I feel like I have to sort of explain why that is or what’s going on there and I don’t know the answer. [Pause crying] I don’t want that to stop.

THERAPIST: Well I appreciate your making that clear to me. It actually makes a lot of [00:32:59]

CLIENT: Sorry, I’m listening.

THERAPIST: That’s all right. The [inaudible at 00:33:04] extends. I mean I’m, as you know, often say things that maybe may feel that are sort of negative or critical or hard to take. [00:33:18]

CLIENT: And I know.

THERAPIST: But I think what you’re sort of saying or pointing out that seems much more central really is the ways I’m there for you and take care of you and make you feel taken care of. And you’re just saying how unclear how that happens or whether and when it will go away. [00:34:12]

And so that when I [inaudible at 00:34:17] ask about does it seem like I can help you this way or can I help you that way or being frustrated this way it, let’s see, well I guess it’s sort of missing the point and sort of demonstrating a way that I don’t get how I am helping and how much that matters, which makes it feel more precarious.

CLIENT: Yes. I guess it feels like there’s this a sort of feeling that it’s on me to be able to articulate that and that’s as hard or harder than telling you ways in which I frustrated you. [00:35:22]

THERAPIST: Yes, definitely.

CLIENT: And so, yes, so I get very, very shy.

THERAPIST: Yes, no I appreciate that you just did.

[Pause]

CLIENT: James asked me yesterday, he said what does Chad think about something, I don’t remember exactly what it was, and I said oh we talked about it. And then I said that’s a silly question, I have no idea what Chad thinks about that. And I said that’s weird. Which is just to say I don’t know, any answer is perfectly retarded. [00:36:54]

[Pause]

Yes, I guess it sort of feels like I have to be able to explain why it’s important and why it helps or it will go away. [00:37:50]

[Pause]

THERAPIST: You know it’s possible I’m well aware that I’m doing it again but it seems also like part of the feeling that the other person might not have a sense of, like I might not have a sense of how much I mean to you or the ways in which how something really matters. [00:38:51]

CLIENT: Yes, so at a time like this when I’m really bad I it’s like things are really bad but also you’re really helping and that really matters and that doesn’t go away even if things are still really bad. And I feel like that sort of feels like a contradiction, it feels sort of hard to carry in my head. And so I worry about you being able to carry it. [00:39:34]

THERAPIST: Right. Well here’s how I understand it. And there may be things that I am missing about it but I imagine at least some of it is that the worse you feel there are fewer places you have to talk about it. And here you can talk about it. I mean you may have a hard time talking about it, you may worry about talking about it, all that stuff obviously that’s there but I think there’s more of a chance and often a lot more opportunity. And I can see how that would at once be as beneficial or even more so when you’re feeling really bad. And yet we both have this thing I can fix it or talking about it will, even if it helps, make it better if that makes sense. [00:40:45]

CLIENT: Yes.

[Pause]

THERAPIST: It’s something that’s also occurring to me, I don’t I think it’s very much a lot between you and me and very important. It sort of has also occurred to me for whatever that you’ve been talking but there are things about this that seem to me to have you and your mom written all over them. [00:41:46]

CLIENT: How do you mean?

THERAPIST: About your wanting help and just feeling like she didn’t know how much she mattered to you.

CLIENT: Oh. That makes a lot of sense. Yes. Sort of hard for me to think about it directly because I get panicked that it’ll all go away. It (ph) gets in the way. If I don’t think about it too much I don’t worry about it too much. [00:42:51]

[Pause]

I don’t know. I feel weirdly like if I tell you how important this is to me that will make you go away and that doesn’t really go, I don’t stop feeling that way. [00:43:53]

THERAPIST: Yes, well what I guess what must be part of what makes it so difficult to tell me like you were saying before how [inaudible] was in ways [inaudible]. [We should stop.] (ph)

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